Definition and Overview

A hernia of the abdominal cavity refers to a protrusion of tissue or internal organs through the weakened part of the abdominal wall. It occurs when a part of the abdominal wall fails to close completely before birth (congenital) or weakens (acquired) due to pregnancy, trauma, or damage caused by surgery. The definitive treatment for the condition is surgery that involves putting misplaced tissue or internal organs back into their proper places and reinforcing the weak area in the abdominal wall. When left untreated, abdominal hernias can lead to serious complications, including life-threatening gastrointestinal obstructions.

There are several types of abdominal hernias, or hernias that occur in between the chest and hips. The most common are:

  • Inguinal hernia - The most common type that occurs when the inguinal canal fails to close before birth or when the abdominal muscles weaken. The weak spot in the abdominal muscles allows the tissue, such as a part of the intestine to bulge.

  • Incisional hernia - A type of hernia that results from a complication of abdominal surgery.

  • Epigastric hernias - Hernias that occur in the epigastrium, which is the part of the upper abdomen between the navel and below the breastbone. This type of hernia is usually present at birth and forms when the abdominal wall muscles are weak or if the abdominal tissue fails to close completely during foetal development.

  • Umbilical hernias - A type of hernia in which a part of the bowel or fatty tissue protrudes near the belly button. It occurs when the opening in the abdominal wall where the umbilical cord passes through while the baby is still in the womb fails to close after birth.

Causes of Condition

Some types of abdominal hernias are congenital in nature or present at birth. Inguinal and umbilical hernias, for example, occur when an opening that is supposed to close before birth fails to do so after the baby is born. Other types, on the other hand, are acquired conditions that commonly develop due to a weakness in some areas of the abdominal wall. Such weakness allows tissues and internal organs to move out of their proper places, especially when there is an increased pressure in the abdomen, which could be caused by the following:

  • Ascites, or the accumulation of fluid within the abdominal cavity

  • Chronic cough and vomiting

  • Complications of abdominal surgery

  • Constant straining during bowel movement or urination

  • Malignant or benign tumours in the abdomen

  • Obesity

  • Peritoneal dialysis

  • Pregnancy

  • Trauma to the abdomen

  • Improper heavy weight lifting

  • Chronic constipation

  • Poor nutrition and smoking

Key Symptoms

All abdominal hernias share some common signs and symptoms, such as pain and a bulge in the weakened part of the abdominal wall. However, each type presents unique symptoms, such as:

  • Swelling around the testicles, a dragging sensation in the groin, and burning sensation at the bulge (inguinal hernia)

  • Fever, infection, foul-smelling discharge, and bowel obstruction (incisional hernia)

  • Constipation, severe abdominal pain, and tenderness in the abdomen (strangulated umbilical hernia)

  • Skin discolouration around the hernia, unbearable pain in the upper belly, and low to high-grade fever (epigastric hernia)

Who to See and Types of Treatments Available

The majority of abdominal hernias are initially assessed through a physical examination. A general practitioner or a paediatrician (for infant patients) can assess a bulging lump. Often, this test alone can confirm a hernia diagnosis. If the patient is showing signs of a strangulated hernia, which threatens to cut the blood supply to the intestine, a computed tomography (CT) scan or x-rays may also be performed to gather more information and properly plan the treatment.

The definitive treatment for abdominal hernias is surgery. Hernia repair is one of the most common surgical procedures performed in the United States with almost a million operations occurring every year.

Surgery to repair an abdominal hernia is called herniorrhaphy or hernioplasty. Generally, herniorrhaphy refers to a surgical procedure used to repair an indirect or direct inguinal hernia but it also applies to any hernia repair. Depending on the patient’s general health condition and other factors, it can be performed under local, regional or general anaesthesia.

For the procedure, the surgeon makes an incision directly over the hernia to make necessary repairs. In the past, surgeons perform the procedure by pulling the tissue around the hernia and suturing them together to close the defect (tension repair). An improvement of this technique is called tension-free repair, which uses a piece of mesh to bridge the hole or reinforce a weakened abdominal wall. This method has a lower incidence of recurrence when compared to tension repair.

Abdominal hernias can also be repaired laparoscopically. The goal of this procedure is the same as traditional open surgery, but instead of making a large incision, it uses several incisions where a laparoscope and miniature surgical instruments are inserted to close the hernia defect using a mesh. A laparoscope is a flexible tube with an attached camera and lighting, which allows the surgeon to visualise and perform the repair while viewing the area on a TV monitor. Laparoscopic or closed repair also has low recurrence rate, and because it uses small incisions, patients experience less pain and discomfort, minimal risk of scarring, and faster recovery time. With this procedure, patients are able to go back to work within just a few days.

References:

  • Fitzgibbons, Jr., R.J., and R.A. Forse. “Clinical practice. Groin hernias in adults.” The New England Journal of Medicine 372.8 Feb. 19, 2015: 756–63.

  • Townsend, C.M., R.D. Beauchamp, B.M. Evers, and K.M. Mattox. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 20th Ed. Elsevier, 2016.

  • Simons MP, Aufenacker T, Bay-Nielsen M, et al. (August 2009). “European Hernia Society guidelines on the treatment of inguinal hernia in adult patients”. Hernia. 13

  • Trudie A Goers; Washington University School of Medicine Department of Surgery; Klingensmith, Mary E; Li Ern Chen; Sean C Glasgow (2008). The Washington manual of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0-7817-7447-0.

Share This Information: